Neuromuscular DiseasesNeuromuscular DiseasesНервно-мышечные болезни2222-87212413-0443Publishing House ABV Press21010.17650/2222-8721-2017-7-3-21-35LECTURES AND REVIEWSЛЕКЦИИ И ОБЗОРЫBotulinum toxin treatment of lower extremity spasticityБотулинотерапия в лечении спастичности нижней конечностиKhat’kovaS. E.ХатьковаС. Е.
Russian Federation
hse15@mail.ruAkulovM. A.АкуловМ. А.
Russian Federation
hse15@mail.ruOrlovaO. R.ОрловаО. Р.
Russian Federation
hse15@mail.ruUsachevD. Yu.УсачевД Ю.
Russian Federation
hse15@mail.ruOrlovaA. S.ОрловаА. С.
Russian Federation
hse15@mail.ruKrylovaL. V.КрыловаЛ. В.
Russian Federation
hse15@mail.ruTreatment and Rehabilitation Center, Ministry of Health of RussiaФГАУ «Лечебно-реабилитационный центр» Минздрава РоссииA.I. Burnazyan Federal Medical and Biological Center, FMBA of RussiaФГБУ ГНЦ «Федеральный медицинский биофизический центр им. А.И. Бурназяна» ФМБА РоссииN.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of RussiaФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н.Н. Бурденко» Минздрава РоссииI.M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaФГАОУ ВО Первый Московский государственный медицинский университет им. И.И. Сеченова Минздрава РоссииHospital for Was VeteransГАУЗ «Госпиталь для ветеранов войн»Россия, Республика Татарстан071120177321350711201707112017Copyright ©; 2017, Khat’kova S.E., Akulov M.A., Orlova O.R., Usachev D.Y., Orlova A.S., Krylova L.V.Copyright ©; 2017, Хатькова С.Е., Акулов М.А., Орлова О.Р., Усачев Д.Ю., Орлова А.С., Крылова Л.В.2017Khat’kova S.E., Akulov M.A., Orlova O.R., Usachev D.Y., Orlova A.S., Krylova L.V.Хатькова С.Е., Акулов М.А., Орлова О.Р., Усачев Д.Ю., Орлова А.С., Крылова Л.В.https://creativecommons.org/licenses/by/4.0https://nmb.abvpress.ru/jour/article/view/210

The article reviews the current concept of lower extremity spasticity, which is a frequent disabling consequence of stroke. Gait biomechanics, step cycle and main pathologic patterns of lower extremity are described (hip adduction, knee flexion, knee extension, foot plantar flexion, equinovarus foot position, toes flexion, hallux extension), including muscles involved in the pathological process. Additionally the article contains detailed information on pathologic principles of lower extremity spasticity development. Special focus is given to sarcomeregenesis as an essential element of the development of potential conditions for muscle tissue adaptation to a new state and restoration of muscle length and strength. At present Botulinum toxin A (BTA) is used in a complex spasticity management programs. The results of clinical studies performed in the last decade supporting the efficacy of Botox® (Onabotulinumtoxin A) in the treatment of spasticity are reviewed. Effective BTA doses are proposed. Authors came to the conclusion that BTA as a part of complex rehabilitation in patients with poststroke spasticity of lower extremity promotes treatment efficacy due to a decrease of muscle tone and increase of range of movements in the joints. BTA should be regarded as an essential part of standard rehabilitation programs. Further studies to define optimal muscles for intervention, BTA doses and rehabilitation schemes are still needed.

 

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